Arc Removal
by Tor Raptor
Summary: After the events of Iron Man 3, Tony wanted his arc reactor GONE. But it wasn't so simple as plucking out shrapnel with tweezers and unplugging the reactor.


**So... because it's almost Christmas, and Iron Man 3 is technically a Christmas movie (try and change my mind on that, I dare you), I am finally posting this quick one-shot that I wrote a few months ago. A little backstory on how this came to be about: those that know my work know that I have a probably unhealthy level of obsession with medical realism, and I wanted to extend it to just about the only thing in a universe based on comic books that has anything to do with how a normal human body functions: Iron Man's arc reactor.**

**I discovered that there were bonus scenes to Iron Man 3 released only in the Chinese version (and unfortunately only in Chinese; I couldn't find a translation or even a subtitled version anywhere). So I begged my friend to translate it for me, and I learned some startling things about that part of the ending montage where Tony has the reactor and shrapnel removed. While scrubbing in, the Chinese doctors (one of whom, Dr. Wu, is the cardiologist that Tony briefly meets in Switzerland in the flashback at the beginning), talk about how badly they would upset the world if Tony Stark died on their table. They're terrified of messing up. And to make matters even more concerning, every simulation they've run up to this point (surgeons often practice on a fake body with simulated vitals to practice for particularly complicated operations), has FAILED. That freaked me out a little bit. So I did more research, learned what the surgical protocol is for fixing a person without a sternum (seriously my search history is WHACK), and wrote this thing. If you've bothered to read all of this, congratulations and thank you, you have now seen inside my head a little bit. I will finally shut up now so you can enjoy the story.**

Dr. Wu entered the exam room swiftly, pinning scans of Tony's chest up on the wall. Pepper had seen the reactor in person countless times, that seemingly innocuous blue circle of light. She'd even stuck her hand into the hole in which it rested—an experience she vowed never to repeat—while Tony coached her through switching it out for a newer model. Yet seeing the scans, which showed in stark detail just how drastically the device interfered with his anatomy, unsettled her. Several miniscule, dagger-like pieces of shrapnel were just visible in the surrounding tissue.

Tony's gaze flitted to the image of his own chest on the wall, then briefly to Dr. Wu, then finally settled pleadingly on Pepper. He shivered, whether from nervousness or fear she didn't know, and almost imperceptibly extended his hand. Pepper immediately stood from her chair by the door and hopped onto the table next to Tony, taking his quivering hand in hers. Wu watched her move with a slight air of suspicion, but she didn't care what he thought. Tony needed her.

"Good afternoon Mr. Stark. Ms. Potts," he greeted kindly. Pepper smiled back, but Tony's forced composure didn't falter. Wu sat down on a rolling stool, the kind present universally in any doctor's office of any specialty, and turned to face them. Pepper scanned his face warily, but found only careful professionalism. This eased her worries, but only slightly. Trusting an unconscious and vulnerable Tony Stark to anybody was a tall order, especially after everything the man had suffered at the hands of those he once considered friends.

"This is an immensely complex operation," Wu began. He didn't have to remind them. Both Pepper and Tony knew exactly how unique this case was; that's why they'd taken so long to thoroughly vet multiple cardiothoracic surgeons from all over the world before choosing the one who was "least likely to fail." Those had been Tony's words, not Pepper's. He understood exactly how complicated his creation was, and had little faith in others' ability to handle it. The only person he'd ever willingly let near it was Pepper herself. The idea of strangers' sterile, gloved hands digging around where only hers had been made Pepper's nerves vibrate like plucked strings. "If you have any questions along the way, don't hesitate to stop me," Wu added. Pepper and Tony nodded rigidly. "Our primary goal is to remove the shrapnel. If we cannot accomplish that, removing the reactor and its housing is no longer a viable option."

"Say what you will about the reactor, it gets the job done," Tony remarked. Pepper detected a strange combination of pride and disgust in his voice.

"Indeed," Wu continued. "But ideally we'll render that job obsolete. However, that's not even half the battle. Thanks to the more detailed scans, we've pinpointed the locations of the remaining pieces and should be able to access and remove them without any large incisions. But as for the reactor, removing such a large structural unit from your rib cage creates an even bigger problem. You don't have a sternum."

"It probably rotted away among the dust on the floor of that cave," Tony stated drily. Wu visibly paled at the implications of such a blunt statement, but plowed forward with his explanation.

"We need to somehow replace it so that your ribcage doesn't collapse in on itself. So we will use a custom titanium implant that we will screw into your ribs."

Upon hearing this, Pepper thought, "Even without the suit, he'll literally be Iron Man." She wasn't sure if she loved or absolutely detested the idea.

"Now, the reactor also functions as a pacemaker, am I correct?" Wu asked.

"Yes," Tony replied dejectedly. Pepper remembered the harsh whine of the monitors when she'd pulled the wire while switching out the reactor. Detaching it caused arrhythmia and eventual cardiac arrest. Tony had explained it all to her one time, when she'd finally brought herself to confront him and demand he tell her everything about it, just in case. Before Yinsen stabilized the shrapnel, the pieces managed to inflict sufficient damage for the resulting scar tissue to make his heart's electrical system malfunction. In addition to powering the magnet that kept the shrapnel away, the reactor provided electrical pulses to keep his heart in proper rhythm. Without it, he'd slip into a potentially fatal arrhythmia.

"We will implant a replacement device to continue to steady your heart rhythm."

"I know," Tony cut in. "I designed it." Pepper remembered him applying himself diligently to the task as soon as he decided to have the reactor out. He refused to let them install a visible, bulky device under his skin, so he made a smaller and infinitely more efficient one. Ironically, this surgery would conclude with one device created by Tony Stark replacing another.

"Of course." Wu smiled one of those forced doctor smiles. "After that, we'll reconstruct the musculature and close up. External scarring should be minimum, thanks to the regenerative capabilities of the Cradle," Wu concluded. Tony had discovered the Cradle through Bruce Banner and his friend Dr. Helen Cho, and insisted it be used so he wouldn't be left with a perfectly circular scar in the center of his chest. "As for recovery time, we're looking at about six weeks for the bone to heal around the screws and achieve full structural integrity of the ribcage.

Tony squeezed Pepper's hand with a strength she didn't think was possible without an Iron Man gauntlet on his hand. His eyes shone. Then, in the softest voice possible, "Will—will I get pain meds?"

Pepper's heart quivered to a halt and shattered like sugar glass. She wanted to push that button again to fry Obadiah, the man who'd sent Tony to that hellhole in the first place. No, she didn't just want to fry him; she wanted him to experience every _second_ of agony that Tony had endured in that stupid cave. In this day and age, _nobody _should have to ask if they'd be given pain meds when they were about to have their chest literally cracked open.

"Of course," Dr Wu replied, sounding as baffled as Pepper was vengeful. Upon hearing this, Tony's iron grip on her hand instantly relaxed and the fear drained from his expression—well, most of it. A healthy amount of fear would remain in both of them until this whole ordeal lay firmly in the past.

~0~

"I can't believe he wanted to do this," Pepper sighed, attempting to massage away a steadily building stress headache. Tony had been in pre-op for all of thirty minutes and she'd already run through more worst-case scenarios than her brain could safely handle without combusting. To make matters infinitely worse, she knew about the simulations. She wasn't supposed to know about them, but anything related to Tony Stark had a manner of finding its way to Pepper Potts.

Because of the novel nature of this procedure, the surgeons had practiced with a computer simulation calibrated to Tony's anatomy. Pepper appreciated the extra effort in ensuring the operation proceeded safely, but she certainly did _not_ appreciate that they didn't ensure they completed at least one successfully before continuing on to a live patient. All the simulations had resulted in patient death. Tony didn't know this—Pepper had made sure of that—but the weight of that knowledge was suffocating. How could she let him go through with this when the odds of him dying stood so dangerously high?

Beneath the crippling nerves, she knew why. Tony needed this fatal weakness eliminated to feel safe again. Knowing he could be killed by a well-aimed blow weighed heavily on both of them, and they'd experienced too many close calls to continue playing this game of Russian roulette. But this surgery was the last risk Pepper was willing to take when it came to Tony's safety. Every time he threw himself into another fight with aliens, monsters, or literal _gods_, Pepper felt exactly as she had when he'd been missing in Afghanistan for months: paralyzed with fear, despair, and an unrelenting desire to bring him home where he couldn't be hurt again. But now she'd brought him all the way to China to be willingly hurt under the guise of medicine.

Rhodey sat down next to her and she almost—_almost—_turned to him and demanded he bring Tony back from in there. Instead, she forced a deep inhale and let it out agonizingly slowly. "He'll be fine," Rhodey assured her. "He's Tony Stark, he'd never let something like this take him down." Pepper forced a smile, which Rhodey warmly returned. Only Rhodey could worry about Tony Stark at a level comparable to Pepper's.

A figure in scrubs emerged and singled them out among the other people in the waiting room. Pepper's heart leapt into her throat—how could something have gone wrong already? But the figure told them in slightly-accented English that Mr. Stark had requested their presence before he was put under. Pepper shot to her feet, eager for another glimpse of Tony alive and healthy before she was subjected to hours of waiting. She and Rhodey followed the woman through a maze of corridors before they came to a stop before a set of glass doors looking in on an operating room.

Pepper immediately wished she hadn't come. When Tony first approached her about having the shrapnel and reactor removed, she hesitated to approve it. But he'd convinced her, as he always did. She involved herself in the process as much as possible, attending all the appointments and helping choose a surgical team, but none of that prepared her for the sight of him on that table.

God, it looked like they'd _crucified _him.

Why did they have to lay him down with his arms outstretched like that? It made for very unsettling imagery. Multiple bags of fluid hung dauntingly at the ready, and the surgeons barely even looked like real people behind all the sterile garb. Pepper wrapped her arms around herself to stop them from shaking. Rhodey stood rigidly beside her and placed a hand on her shoulder. She thought the impact might just knock her to the ground.

"Tony asked me to be here," she silently reminded herself. Over and over again. She doubted he understood what he was doing by making her watch this. One of the indistinguishable figures placed a mask over his face, and she saw his eyes flit her direction. His right hand, with its index finger enclosed in a pulse oximeter, curled into a thumbs-up. He was ready for this—though Pepper certainly wasn't. Rhodey solemnly returned the gesture; Pepper forced a weak smile and fought back tears.

The second Tony's eyes slipped shut, she bolted. She didn't dare stay long enough to watch him be intubated or to catch a glimpse of any surgical instruments. Any more proof that this was really happening, that Tony's life rested in the hands of near strangers, would push Pepper over the edge on which she already teetered precariously.

She hurried back to the waiting room and sat down before she passed out. She clutched her head in her hands in an attempt to keep the stress from forcing her brain out her ears. "Pepper," Rhodey's voice managed to pierce the thrumming in her eardrums. "It'll be okay." She wanted to accept his reassurance, but she couldn't. All she could think about were the stupid _simulations._ They'd all failed, which left her no evidence to indicate that this one, the only one that mattered, would succeed. And in the seemingly likely event that it failed…then what?

"What if it doesn't work?" she asked aloud, picking up her head long enough to look Rhodey in the eye.

"It will work. All of Tony's plans work in the end," Rhodey reminded her. Somehow, that one comment made her forget all her worries about the simulations. She stopped imagining worst case scenarios and instead pictured the intended outcome: Tony free of the shrapnel that had endangered him for so many years, and free of the device that announced his fatal weakness to the world. Besides, once Tony had decided he wanted to do this, there was nothing Pepper could have done to stop him. Once Tony set his mind to something, Pepper had no choice but to either go along with it or retract all investment in the situation. And this was a situation that she couldn't possibly remove herself from.

She remembered when Tony first starting doing hero work as Iron Man. She'd told him, "You're going to kill yourself, and I'm not going to be a part of it." But she couldn't imagine her life without it being irreversibly tied to Tony's. It would be a boring life, that's for certain.

~0~

"He made it," Rhodey told her. "He's fine." Pepper had sent him for information, certain that if she did it herself she'd break down before she could get a single word out. Besides, hearing it from Rhodey just felt better than hearing it from a scrubbed stranger. Pepper literally sagged with relief. She lost count of how many hours she and Rhodey had sat waiting, but her back hurt from the extended time spent seated in the same position.

"Can we see him?" she asked meekly. Rhodey nodded and gestured for her to follow him. A part of Pepper feared what she might find when they arrived. But the rest of her desperately needed to be reunited after so many trying hours apart.

She lost track of the steps they took down more nameless hallways, but none of that mattered but for the final destination. Tony. Alive and whole. All the breath left Pepper's lungs in one massive huff. He still slept, bare chest littered with electrodes to make sure the new pacemaker kept his stupidly stubborn heart in rhythm. His left arm wrapped around a scarlet, heart-shaped pillow resting on his chest. Rhodey, smirking, snapped a photo, and Pepper restrained herself from reprimanding him for it. She had to admit it was adorable. Its purpose, though—to help support his newly-reassembled ribcage if he coughed—was anything but. Pepper doubted Tony would let it stay where it was supposed to be for longer than twenty seconds after regaining consciousness. The first ten would be spend in a bleary haze, the next ten making a stupid joke, then the pillow would be discarded.

She was right. An hour or so later, Tony's eyelids began to flutter open. Roughly fifteen seconds later he was awake enough to register the pillow. Pepper watched his brow furrow in disapproval. His mouth worked around a word, but no sound emerged from his throat. He tried again, and this time succeeded in hoarsely growling, "Here's your proof that Tony Stark has a heart." He threw the pillow at her—well, he tried to. It didn't fly even half as far as he clearly intended it to, and merely landed by his hip.

"I don't need any more proof," Pepper said gently. She picked up the stuffed heart and returned it to its proper place, tugging Tony's wrist to coax him into clutching it again. She was just in time, as his throat finally protested enough to start him coughing. Despite pain-medicine induced haze he must've been in, Pepper knew the fit must hurt like hell. Tony held the stuffed heart to his chest until the fit subsided, and Pepper held back a smirk. Tony Stark never quite knew what was good for him.

"Proof that Tony Stark still needs a little help from this extra heart," Pepper retorted, pointing to the pillow. He rolled his eyes, but she detected the barest hint of a smile at the corner of his mouth.

"So, what's the verdict? How long have I got?"

"Tony! Don't even joke about that."

"Too soon Tones," Rhodey confirmed. "Too soon."

"Why so tense? You're both sucking the life out of the party," Tony complained.

"There's no party," Pepper insisted.

"How about a pity party? I think I'm entitled to throw a pity party at this time if I so choose."

"Sure, go all 'woe is me.' That's not your style," Rhodey reminded him.

"Neither is this pillow. Do they sell Iron Man ones in the gift shop? I'd kill for some Iron Man merch."

"Why would Iron Man need Iron Man merch?"

"You gotta support the brand, man."

"How much morphine do they have him on?" Rhodey asked Pepper. She shrugged. She didn't care if they dosed him up to his gills if it meant minimal pain. She vividly remembered him asking if he'd be given any at all. "Fine. I'll see if I can find you a more suitable pillow." Rhodey exited, leaving Pepper alone with Tony. She took a seat at his right side so she could hold his free hand.

"Do you remember giving me and Rhodey that thumbs up?" Pepper asked.

"Nope."

"I didn't think so. But it was nice to know that you were ready, even if I wasn't."

"Why wouldn't you be ready?"

"Stop being so nonchalant, Tony, this is a big deal," she insisted. "I was worried things would go wrong…" she almost mentioned the simulations, but stopped her train of thought just in time. Tony had just proven he was far more resilient than any computer-generated rendition of him. She should've known that no software could accurately predict how Tony Stark would handle physical stress.

"Nothing went wrong," he told her.

"I know that now, but the waiting and wondering was the hard part."

"M'sorry," he mumbled, fingers squeezing the edge of his pillow.

"No, don't you dare apologize." She looked at him sternly. God, since when did Tony Stark apologize for anything? Where was the man who did as he pleased without question, who walked all over anyone who stood in his way with a sarcastic remark and a curt dismissal? "Iron Man happened," Pepper thought. That metal suit had both saved and endangered his life on multiple occasions, but Pepper knew he'd never give it up. He'd never rest if he put the suit down before the universe had been cleansed of potential threats of any size.

"I'm sorry Pepper," he repeated, more coherent this time. "I just…I needed it out. Can't really explain it."

"I understand," she assured him. "And it's out now. You're fine."

"I suppose I can't go through metal detectors in airports anymore," he quipped.

"Tony, you have a private plane. When was the last time you went to an airport?"

"Don't remember."

"Exactly. Metal detectors are the least of your worries."

"The good news is, if I ever need open-heart surgery, they can just weld me back together."

Pepper couldn't hold back a chuckle. If anyone had the right to make fun of the situation, she supposed it was Tony. She didn't always appreciate his morbid sense of humor, but if he was genuinely cracking jokes now it meant he wasn't hurting. She'd take it. "I suppose you're right. But don't take that as an invitation."

"I won't. Promise." He pulled his right hand out of their shared grip and wrapped his pinky finger around hers.

"I will hold you to this, Mr. Stark," she warned.

"Okay Miss Potts," he replied sleepily.

"You should take a nap," Pepper suggested. Tony coughed again, clutching the pillow against his chest, and shook his head.

"Don't think I can," he admitted.

"Why not?"

"No night light." He nodded to his reactor-free chest.

"You're an adult. I think you'll manage."

"M'kay. Besides, you're here." He yawned, let his head loll to the side, and closed his eyes. "You'll keep away the monsters."

~0~

Pepper fell asleep not long after Tony did. The mental exhaustion from the trying day quickly became too much to overcome. She rested peacefully until a distressed whimpering penetrated the fog of sleep. Pepper's eyes shot open and instantly fixated on the figure before her. Tony's left arm clutched the pillow so tightly she couldn't even tell it was heart-shaped, while his right hand clawed at the site where the reactor had been. Pepper wanted to cover her ears against the harsh cries that escaped Tony's throat. For an instant, Pepper thought he was seizing. Her hand hovered over the emergency call button, but then it occurred to her what was really going on.

The weight of the reactor was gone. And for the past several years, that had spelled _danger._

Pepper grabbed his right hand away from his chest and clutched it tight, hoping that somehow the sensation would register and let him know he was safe. "Tony," she whispered, hoping desperately that he would hear her. "You're alright." She rubbed her thumb across the back of his quivering hand, but he didn't still. His eyes snapped open in panic, his breath heaving.

"Tony, look at me," she instructed sternly. He turned his head just enough to lock eyes with her.

"It's gone," he choked.

"It's fine, Tony. They took out the shrapnel, you don't need it anymore," she assured.

"No?" his brow furrowed in confusion.

"No." Pepper shook her head and smiled. "Never again."

~0~

A few minutes after Tony had fallen back asleep, Rhodey returned with, sure enough, an Iron Man pillow. He looked from Pepper to Tony's sleeping form, and Pepper nodded at him with a smile. He gently removed the heart from Tony's grip and replaced it with the new pillow. Pepper reached out and accepted the heart pillow from Rhodey, hugging it to her chest for comfort.

"He had a nightmare," she told Rhodes.

"Yeah?"

"He was afraid because the weight of the reactor is gone," Pepper explained.

"Damn, I didn't even think about that. It must feel so wrong."

"What's wrong is that the reactor was there in the first place."

"Pepper, that's in the past. Yes, it was horrible and it shouldn't have happened, but we can't change the fact that it did. But now it's gone, and we don't have to worry about him so much," Rhodey said with a wistful smile. They both knew that last part wasn't quite true. Pepper Potts and Colonel James Rhodes would spend the rest of their lives worrying about Tony Stark.

~0~

On the day of his discharge, five days after surgery, the doctors presented Tony with a parting gift: his arc reactor. An innocent-looking canister of metal that had ensured his continued survival for so long. In the moments he wasn't sleeping, Tony caressed it the entire flight home. Pepper wondered what he would eventually do with it.

If it were up to her, she'd have it preserved similarly to his first reactor, encased in glass to be displayed as proof of his fallibility. But she suspected Tony had other plans, likely less sentimental plans. Frankly, she didn't care what he did with it. All that mattered was that it no longer threatened his safety. Now, if only Pepper could get him to stop pulling crazy stunts as Iron Man, maybe her stress levels would return to normal—well, normal for a CEO of a major company. But she knew that would never happen. Tony Stark and Iron Man were one and the same.


End file.
